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The Division of Workers' Compensation (DWC) Will Need to Weigh the Benefits of Remaining Consistent with the Current MTUS Structure Against the Ease of Implementing the Formulary

• To remain consistent with the MTUS guidelines, DWC will need to either adopt existing the guidelines and formulary (the Work-Loss Data Institute's ODG or The Reed Group's ACOEM) or derive the formulary drug listing from MTUS guidelines.
• The existing sources have advantages and disadvantages. The ODG guidelines are more comprehensive and updated regularly. The formulary drug listing has prospective review (PR) requirements and could be implemented off the shelf. The MTUS guidelines for chronic pain are based on ODG, although most MTUS guidelines are based on ACOEM. The ACOEM guidelines have a more rigorous development process but are less comprehensive. Updates occur every three to five years. The drug recommendations are condition-specific, with no PR requirements. DWC would need to develop a formulary drug listing and PR requirements.
• The MTUS guidelines are outdated. An MTUS formulary would require updating the guidelines; developing a formulary drug list and PR requirements; and, if the current multisource structure is retained, integrating guidelines from different sources into a single formulary.
• The Labor Code's different administrative processes for updating the treatment guidelines and the formulary pose challenges for maintaining currency and consistency between the guidelines and formulary recommendations.